OPEN ENROLLMENT 2015 WELCOME to the 2015 Benefits Open Enrollment at Lafayette College. This year’s Open Enrollment begins on October 28 and continues through November 19, 2014. All of the plans offered during the Open Enrollment period are based on a calendar year (January 1 through December 31, 2015). The following pages of this booklet summarize the benefit options for your consideration during this Open Enrollment period. This information is to be used as a general guide and does not reflect a complete summary of the plans. Detailed plan summaries can be found in the Office of Human Resources and on the Human Resources web page, hr.lafayette.edu. Welcome to the annual benefits open enrollment period for 2015. As you are aware, the health care marketplace—both here in the Lehigh Valley and across the country—is continually changing. That’s why, each year, we are faced with the task of responding to those conditions in order to create the best combination of coverage, premiums, and networks that will give our community the most comprehensive plan at the best possible price. In order to achieve that end, we completed a rigorous annual review of our current policies and coverage, our relationship with our carrier, changes in the federal guidelines, and the College’s budget. Our utilization of the plans, along with fees imposed by the implementation of the Affordable Care Act (ACA), creates continuing upward pressure on premiums. We are pleased to report that the Office of Human Resources has been able to mitigate those pressures for 2015 and negotiate a 4% increase based on the plan designs offered. (The final renewal from Highmark was 9.5% based on our current plan designs, and 4% net of plan design changes.) This 4% increase to the premiums for the healthcare plans is consistent with the percentage allocated in the College’s budget for January 1, 2015. We were able to achieve this outcome by aggressively negotiating with local carriers. Based on the outcome of those negotiations, we have selected Highmark Blue Shield, which utilizes the Highmark Blue Shield PPO network within Pennsylvania and offers access to the Bluecard Worldwide network outside of Pennsylvania, as our carrier for 2015. For the coming year, we have also developed a wider range of health plan choices for our community, so that our members can select a health care plan that best suits their personal health care needs and the needs of their families. We are pleased to be able to offer three plan choices; 1) Standard PPO Plan; 2) Low Deductible PPO Plan; and 3) High Deductible Plan with HSA. For 2015, for the Standard PPO Plan option, the College will continue to pay 90% of the medical premium for an individual employee; 78% for an employee with child/ children; and 67% of the combined premium for employees and their spouses/partners. Further details regarding the three medical plans with Highmark Blue Shield can be found on the following pages. If you select the Standard PPO plan for next year, the College will maintain the percentage contributed to each tier under the current PPO plans. The applicable deductibles, coinsurance, and copays are reflected on page 6. If you elect to enroll in the Low Deductible PPO Plan (lower copays, deductibles, and coinsurance), the College will contribute to that plan the same amount it contributes to the Standard PPO plan, with the employee paying the difference between that amount and the premium for the Low Deductible PPO coverage. If you select the Qualified High Deductible Health Plan (QHDHP) with the HSA, the College will contribute toward it an amount equal to the College’s contribution toward the Standard PPO plan. This will include the College contributing $1500 in 2015 to an HSA for individual employees, and $3000 in 2015 for all coverage tiers above single coverage. (More about how the HSA works to follow.) The following pages will provide greater details for each of the three options. We will be holding a series of meetings for employees during the open enrollment period in addition to hosting the annual Benefits Fair on October 30. During the annual Open Enrollment period you may make changes to your medical, dental, flexible spending and optional/supplemental life insurance coverage. Because of the changes to the medical plan options for 2015, all employees are required to complete and submit an enrollment form. If you are not electing to receive medical coverage from the College, you must complete a waiver of coverage form. Your completed forms must be returned to the Office of Human Resources by Nov. 19, 2014. New Me d i c al Pl an Cho i ce s Fo r 2 015: The College is pleased to be able to offer an expanded lineup of plan offerings. As mentioned earlier, there will be three medical plan offerings consisting of a “Standard” plan, a “Low Deductible” plan and a “Qualified High Deductible” plan. All three plan designs are based on a PPO model. In a PPO, a member does not need to select a primary care physician, and does not need a referral to see a specialist. The following is a brief summary of the plan options for 2015. open Enrollment 2015 | 3 • S tandard PPO Plan: A hybrid-type PPO plan which merges the attributes of the current PPO 1 and PPO 2 plans. The College’s premium contributions for all medical plans will be based upon this plan. (The College’s premium allowance for this plan, therefore, determines the premium allowance for the other two plans.) This plan may be attractive to an employee who wants a plan which is most similar to the current health plans offered in 2014. • L ow Deductible PPO Plan: A PPO plan which offers richer benefits (lower out-of-pocket expenses), in exchange for increased monthly premiums. This plan could be attractive to an employee willing to pay more in premiums (offered on a pre-tax basis), but who wants to reduce/limit the employee’s own out-of pocket costs. • Q ualified High Deductible Plan w/HSA: A qualified high deductible health plan (PPO based) which requires greater member out-of-pocket expense in exchange for lower monthly premiums. This plan will also feature a Health Savings Account (HSA) which the College will fund at 50% for both the individual and family coverage tiers. A Health Savings Account, or HSA, is an interest bearing savings vehicle partially funded by the College (50%) and the employee (if desired), which can be used to pay for qualified health care expenses not covered in-full by the medical plan, on a pre-tax basis. If elected, the employee’s contribution is deposited into this account during the year and used to 4 | open Enrollment 2015 pay for qualified expenses incurred by the member. The College will make its contribution to this account (50% of the deductible) at the beginning of the year. Money in this account, and any interest, is tax-free if used to pay for qualified medical expenses. It works very much like a flexible spending account (FSA) with some advantages. In addition to higher annual contribution limits, the money in the account is fully owned by the employee, and the balance can be carried forward into future years without fear of forfeiture. Note: IRS guidelines prohibit an employee from participating in a medical FSA account if they are enrolling in the QHDHP/HSA option. Note: Maximum HSA contribution limits (employer plus employee) for 2015 will be $3350 for individual and $6650 for family. Employees age 55 and older may contribute up to an additional $1000 for 2015. Impo r tant Remind e r Re g ar d ing Depend ent Child r en E li gib ilit y fo r 2 015 Under the Health Care Reform legislation (Patient Protection and Affordable Care Act), all children (natural, adopted, or step children) under age 26 are considered “dependent” regardless of their student status, marital status, and tax filing status. This legislation allows employees to cover children up to the age of 26, under the College’s medical (not dental) plans. However, HSA funds can only be used on dependent children claimed on your tax return. E LE C TI ON R E Q U IR E D Fle xib le Spend ing Account s (F SA) Because of the introduction of new medical plan designs for 2015, all employees must complete either a Highmark medical plan enrollment form (if selecting one of the three medical plan options), OR, a benefits waiver form. A debit card will be issued to all employees enrolling in the medical flexible spending account for 2015. All employees electing to enroll for the 2015 calendar year must complete a new enrollment form, even if you are currently enrolled in the program for 2014. Dental Pl an fo r 2 015 The College is remaining with Blue Cross Dental as its dental insurance carrier for 2015. While the annual benefit remains at $1,000, the “rollover benefit” will continue into 2015. With this rollover feature, employees can rollover up to $500 of unused dental benefit from 2014 into 2015. The maximum annual benefit as a result of this rollover feature is $2,000. A summary of the dental plan benefits can be found on page 9. Fle xib le s pend ing Ad mini s tr ato r Change fo r 2 015 New Flexible Spending Account Administrator The College has selected Discovery Benefits as its new flexible spending administrator for 2015. Any “carryover account balance” (up to $500 in the medical flexible spending account only) will be transferred to those new accounts with Discovery Benefits after March 31, 2015. Note: Employees electing the High Deductible medical plan option with the HSA funding account are prohibited by IRS regulations from also enrolling in a medical flexible spending account for 2015. Employees can elect one account or the other, not both. F SA Annual E lec ti on As a result of health care reform legislation under The Patient Protection Act, the annual FSA limit for the medical flexible spending account continues to be $2,500 per employee. The dependent care account maximum remains at $5,000 per family. Details regarding the flexible spending account plans can be found on page 10. open Enrollment 2015 | 5 Highmark Blue Shield The Highmark plans are fully insured PPO plans which locally utilize the Highmark Blue Shield PPO network of hospitals and medical providers. A current listing of local providers can be accessed online at highmarkblueshield. com. In addition, if you wish to obtain medical services from Blue Shield participating providers outside of the local area, you may use the BlueCard Worldwide PPO network. You can access the BlueCard Worldwide PPO directory from the Highmark website. For more information about Highmark Blue Shield call 1-800-632-5071. Q HDHP + HSA Advantage s • Tax savings on contributions made to the HSA for eligible expenses • Contributions made by employers may be excluded from gross income • Funds belong to the employee even after employment terminates • Funds can be used to cover a wide range of qualified medical expenses—including those incurred by spouse/dependents (as long as they can be claimed on the individual’s federal tax return) • Unused funds in health savings accounts can rollover from year to year for future medical needs • Acts as a savings vehicle for members nearing retirement age • Offers lower premiums for employees • May use HSA funds for premiums after retirement Standard PPO Benefits Deductible Individual Family In-Network Out-of-Network $700 $2,100 $2,000 $6,000 (applies to all services unless a copayment is applied or otherwise noted) (applies to all services unless a copayment is applied or otherwise noted) 15% 85% 45% 55% $1,350 $4,050 $4,000 $12,000 Individual Family $6,600 $13,200 None Lifetime Maximum Physician Office Visits Primary Care Specialists Preventive Unlimited Unlimited $15 copay $25 copay $0 copay; deductible waived 45% coinsurance after deductible 15% coinsurance after deductible 15% coinsurance after deductible 45% coinsurance after deductible 45% coinsurance after deductible 15% coinsurance after deductible 15% coinsurance after deductible 45% coinsurance after deductible 45% coinsurance after deductible 15% coinsurance after deductible 45% coinsurance after deductible Covered in full/$100 ER copay (waived if admitted); deductible waived 15% coinsurance after deductible Covered in full/$100 ER copay (waived if admitted); deductible waived 45% coinsurance after deductible Health Savings Account Employer Contribution Individual Family Coinsurance (Eligible Charges) Member Pays Plan Pays Medical Out-of-Pocket Max Individual Family True Out-of-Pocket Maximum (includes deductible, coinsurance, and copays for Medical and Rx) 45% coinsurance after deductible (Pediatric/Adult Exams) Maternity/Newborn Baby Care Inpatient Hospital Services (professional fees and facilities) Surgery & Anesthesia Outpatient Hospital Services (professional fees, facilities, lab, x-ray, radiation therapy, chemo therapy, anesthesia and surgery) Radiology Testing/Imaging (x-rays, MRI, CT, PET) Emergency Room Services Hospice Care Prescription Drugs N/A (Express Scripts) Deductible Individual Family Retail–up to 31-day supply Generic Brand Formulary Brand Non-Formulary Mail Order–up to 90-day supply Generic Brand Formulary Brand Non-Formulary Annual Preventive Mammogram $200 $600 $10 copay $35 copay $50 copay $20 copay $70 copay $100 copay Covered in full; deductible waived 45% coinsurance after deductible $0 copay; deductible waived 15% coinsurance after deductible $25 copay 15% coinsurance after deductible $25 copay 45% coinsurance after deductible 45% coinsurance after deductible 45% coinsurance after deductible 45% coinsurance after deductible 45% coinsurance after deductible (age 40 and over) Preventive Gynecological Exam Mental Health Inpatient Care Mental Health Outpatient Services Substance Abuse Care: Inpatient Substance Abuse Care: Outpatient 6 | open Enrollment 2015 Q High Deductible+HSA In-Network Low Deductible PPO Out-of-Network In-Network Out-of-Network $3,000 - Individual Tier Only $6,000 - All Other Tiers $6,000 - Individual Tier Only $12,000 - All Other Tiers $300 $900 $1,200 $3,600 (applies to all services unless otherwise noted) (applies to all services unless otherwise noted) (applies to all services unless a copayment is applied or otherwise noted) (applies to all services unless a copayment is applied or otherwise noted) 20% 80% 50% 50% 10% 90% 25% 75% N/A N/A $10,000 $20,000 $1,200 $3,600 $2,250 $6,750 $5,000 $10,000 $10,00 0 $20,000 None Unlimited Unlimited $6,600 $13,200 Unlimited 20% coinsurance after deductible 50% coinsurance after deductible 25% coinsurance after deductible $0 copay; deductible waived 50% coinsurance after deductible $10 copay $20 copay $0 copay; deductible waived 20% coinsurance after deductible 20% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible 10% coinsurance after deductible 10% coinsurance after deductible 25% coinsurance after deductible 25% coinsurance after deductible 20% coinsurance after deductible 20% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible 10% coinsurance after deductible 10% coinsurance after deductible 25% coinsurance after deductible 25% coinsurance after deductible 20% coinsurance after deductible 50% coinsurance after deductible 10% coinsurance after deductible 25% coinsurance after deductible 20% after network deductible 20% after network deductible 20% coinsurance after deductible 50% coinsurance after deductible Covered in full/$100 ER copay (waived if admitted); deductible waived 10% coinsurance after deductible Covered in full/$100 ER copay (waived if admitted); deductible waived 25% coinsurance after deductible $1,500 $3,000 25% coinsurance after deductible N/A N/A Rx Deductibles are Integrated with Medical Deductibles Unlimited $150 $450 $20 copay after deductible $40 copay after deductible $50 copay after deductible $10 copay $30 copay $45 copay $40 copay after deductible $80 copay after deductible $100 copay after deductible Covered in full; deductible waived 50% coinsurance after deductible $20 copay $60 copay $90 copay Covered in full; deductible waived 25% coinsurance after deductible $0 copay; deductible waived 20% after deductible 20% after deductible 20% coinsurance after deductible 20% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible $0 copay; deductible waived 10% after deductible $20 copay 10% after deductible $20 copay 25% coinsurance after deductible 25% coinsurance after deductible 25% coinsurance after deductible 25% coinsurance after deductible 25% coinsurance after deductible MyCare Navigator SM THE 24/7 DEDICATED CARE ADVOCATE YOU AND YOUR EMPLOYEES NEED...AND DESERVE Navigating the health care system shouldn’t be like walking through a maze, getting caught in endless twists, turns and dead ends. It shouldn’t take multiple phone calls and tons of paperwork for patients to get the care services they need. It should be a lot quicker and easier. Now it is! Highmark members and their families (including spouses, parents, parents-in-law and dependent children) now have a built-in guide who navigates the ins and outs of the health system for them. Getting their care questions answered and problems solved is as easy as dialing 1-888-BLUE-428. And this free service is available any time of the day, any day of the week. INSTANT ACCESS TO BROAD SUPPORT Do your employees need help finding a doctor…. coordinating their care…understanding their care options… locating helpful services... handling provider billing issues? With myCare Navigator, they get a dedicated health advocate who addresses and resolves these and other care issues. This patient advocate service is available to Highmark members and their family, free of charge and free of hassles! Encourage your employees to get the help they need to navigate the health care system easily and effectively! ONE NUMBER fOR ALL YOUR ANSwERS! CALL 1-888-BLUE-428 THROUGH myCARE NAVIGATOR, YOUR EMPLOYEES CAN: • Find the right care provider • Share their medical records • Get appropriate care services • Make informed care decisions • Locate helpful services • Understand their care costs • Get maximum value from their health coverage! highmarkBlueshield.com Blue Cross Dental Plan Option The Blue Cross Dental plan focuses on the importance of regular and preventive dental care. The plan is administered by Capital BlueCross. The plan provides members significant savings by receiving services from participating dental providers, and also allows members to receive services from non-participating providers of their choice with insurance reimbursements based on the contracted allowances. The Blue Cross Dental plan provides coverage for the full range of dental care needs, such as routine preventive and diagnostic, basic and major restorative, and orthodontic services. The plan utilizes the national Blue Cross network of dental providers. You can locate a participating dentist at their website: www.capbluecross.com. When using a participating (in-network) dentist for diagnostic and preventive care, eligible services are covered at 100%. When you receive basic restorative, major Diagnostic and Preventive restorative, or orthodontic services, you are responsible for the coinsurance amounts of 20%, 50%, and 50% respectively. If you use an out-of-network dentist, the plan pays the same set allowance for the particular dental service as it does for a participating dentist. You are responsible for the coinsurance amount plus the difference between the out-of-network dentist’s actual charges and the Blue Cross Dental established allowance. There is no deductible applicable under this plan. Although the annual dental benefit amount per person, per plan year, is $1,000, the plan allows for a rollover benefit of up to $500 of unused dental benefit from one year to the next, for a maximum annual benefit of $2,000 per person. Under the Blue Cross Dental plan, services covered under the “preventive and diagnostic” category (100%) are not counted towards the annual $1,000 benefit amount. The lifetime maximum benefit amount for a child’s (up to age 19) orthodontic care is $1,000. Basic Restorative Major Restorative Orthodontia Covered at 100% Covered at 80% Covered at 50% Covered at 50% Routine Exams (one every six months) Basic Restorations Inlays Diagnostic Endodontics Onlays Active Treatment Cleanings (one every six months) Denture Repairs X-rays Simple Extractions Crowns (one per tooth in five years) (Covers children to age 19) Bitewings (one set of four every six months) Anesthesia Prosthetics (one per tooth in five years) Full mouth (one every three years) Specialist Consultations Pontics Fluoride Treatments (one every six months till age 19) Non-Surgical Periodontics Sealants (one tooth every three years; permanent first molars to age 10; permanent second molars to age 15) Oral Surgery Retention Treatment $1,000 lifetime maximum per patient Surgical Periodontics Palliative Emergency Treatment For more information about BlueCross Dental Plus call 1-800-962-2242 or visit their web site: www.capbluecross.com open Enrollment 2015 | 9 Lafayette College Medical/Dental Insurance Premium Rates Monthly Payr oll De d uc ti ons fo r Ac tive Employee s Beginning January 2015 MONTHLY TOTAL PREMIUM Actives COLLEGE CONTRIBUTION* EMPLOYEE CONTRIBUTION Individual $555.00 $499.50 $55.50 Employee plus Spouse/Partner $1,523.97 $1,021.26 $502.71 Parent/Child $1,296.75 $1,019.25 $277.50 Highmark Standard PPO Parent/Children $1,363.26 $1,067.41 $295.85 Family $1,590.46 $1,068.36 $522.10 Highmark Qualified High Deductible/HSA Individual $527.84 $499.50 $28.34 Employee plus Spouse/Partner $1,357.81 $1,021.26 $336.55 Parent/Child $1,192.65 $1,019.25 $173.40 Parent/Children $1,240.99 $1,067.41 $173.58 Family $1,406.15 $1,068.36 $337.79 Highmark Low Deductible PPO $599.30 $499.50 $99.80 Employee plus Spouse/Partner $1,648.09 $1,021.26 $626.83 Parent/Child $1,402.37 $1,019.25 $383.12 Individual Parent/Children $1,474.28 $1,067.41 $406.87 Family $1,720.00 $1,068.36 $651.64 $39.20 -- $39.20 Capital Blue Cross Dental Individual 2-Party $78.39 -- $78.39 Family $101.37 -- $101.37 * The college contributions shown for the High Deductible/HSA plan does include the annual HSA contribution of $1500 for individual and $3000 for family. Flexible Spending Accounts (FSAs) For 2015, the new administrator for the flexible spending account program will be Discovery Benefits. A Debit Card will be issued to all members enrolling in the medical FSA for 2015. This program allows employees to save money on a pre-tax basis to pay for unreimbursed qualified health/medical care expenses and certain dependent care expenses. Reimbursements are, in essence, the employee’s own money paid back tax-free. The plan year is from January 1 through December 31. Note: Employees may carryover up to $500 of unused benefit in their 2014 medical flexible spending account into the 2015 plan year. The carryover amount then may be used during that entire following plan year to pay for or reimburse qualified medical/health care expenses. (The carryover allowance does not apply to dependent care accounts.) 10 | open Enrollment 2015 The annual flexible spending account contribution maximum for 2015, remains at $2,500. However, because of the carryover rule change, a participant may be able to contribute $2,500 in 2015, plus up to $500 of unused carryover funds from 2014, for a total available amount of $3,000 for 2015. In this account, you save a portion of your pay with pre-tax dollars, thereby reducing your federal income tax burden. Specifically, the plan allows you to contribute your own money, before federal income tax, Social Security tax, and state tax (exceptions apply) to accounts, which will then be used to reimburse you for qualified out-of-pocket medical or dependent care costs. Visit www.discoverybenefits.com. Flexible spending accounts operate on a calendar year basis. If you wish to participate in 2015, you will need to complete the FSA enrollment form for the medical flexible spending account and/or the dependent care flexible spending account. �. Dependent care: You may have money deducted from your pay on a pre-tax basis to cover costs for dependent care. The maximum limit for the calendar year is $5,000. You save money by paying for these expenses with pre-tax dollars. �. Medical/Health care: You may have money deducted from your pay on a pre-tax basis to cover qualified medical expenses that are not covered by your medical, dental, or vision insurance. The maximum contribution limit for the 2015 calendar year is $2,500. You save money by paying for these expenses with pre-tax dollars. Reminder: Because of the healthcare reform legislation, you may utilize funds in your medical flexible spending account to pay for qualified medical expenses for dependents to age 26. Optional/Supplemental Life Insurance The College continues to offer optional/supplemental life insurance through Sun Life Financial, which provides additional life insurance for employees over and above the non-contributory (free) coverage already provided by the College. Eligible employees are able to buy, or increase, their supplemental life coverage in increments of $10,000, up to 5 times their annual salary, not to exceed $500,000. Employees who are currently enrolled in optional life (at any amount) would be eligible to increase their optional life insurance coverage by up to an additional $20,000, without evidence of insurability, during this and future open enrollment periods. Premiums, which are determined by the amount of the insurance taken and the age of the employee based on agebanded rates, are fully paid by the employee. If you wish to make any changes to your current level of supplemental/ optional life insurance, please complete the optional life enrollment form. If required for underwriting purposes, you will be sent a personal health application from the Office of Human Resources, once you complete and return the enrollment form. If you wish to participate for 2015, you must complete and sign the Discovery Benefits flexible spending enrollment form. Additional Information IMPORTANT: Remember that you should fund the flex accounts only for eligible expenses that you expect to incur in 2015. If there are any questions regarding the information contained in the booklet, or any questions related to the use of Employee Self-Service, please contact the Office of Human Resources at (610) 330-5060. open Enrollment 2015 | 11 All Open Enrollment forms and related information can be accessed via the Human Resources website: hr.lafayette.edu. Open Enrollment Informational Meetings • Benefits Fair, Thursday, October 30, 2014, 10:30 a.m. to 3 p.m., Marlo Room, Farinon • Monday, November 3, 2014, 11 a.m., Oechsle 224 • Monday, November 3, 2014, 5 p.m., Limberg Theater • Wednesday, November 5, 2014, 12 p.m., Hugel 100 • Monday, November 10, 2014, 2 p.m., Hugel 100 • Thursday, November 13, 2014, 11 a.m., Hugel 100 • Monday, November 17, 2014, 3 p.m., Oechsle 224 Office of Human Resources 12 Markle Hall • Easton, PA 18042 (610) 330-5060 • Fax (610) 330-5720 hr.lafayette.edu
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